36D2012140 CLIA NUMBER - COLBERT FAMILY HEALTH & WELLNESS

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Laboratory Demographics

CLIA Number: 36D2012140

Facility Name: COLBERT FAMILY HEALTH & WELLNESS

Facility Address:
2580 SHILOH SPRINGS ROAD
TROTWOOD, OH
ZIP 45426
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Facility Phone Number: 937 532-3992

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1619295425

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	36D2012140
LAB Type	Independent
Facility Name	COLBERT FAMILY HEALTH & WELLNESS
Street	2580 SHILOH SPRINGS ROAD
City	TROTWOOD
State	OH
ZIP	45426
Phone	937 532-3992
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024